Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press53510.17650/2686-9594-2022-12-2-28-35ORIGINAL REPORTSОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯRisk factors for urgent complications of colorectal cancerОценка факторов риска, влияющих на развитие ургентных осложнений колоректального ракаShchaevaS. N.ЩаеваС. Н.
Russian Federation

Svetlana Nikolaevna Shchaeva

28 Krupskоу St., Smolensk 214019

Светлана Николаевна Щаева

214019 Смоленск, ул. Крупской, 28

shaeva30@mail.ruSmolensk State Medical University, Ministry of Health of RussiaФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России0506202212228350506202205062022Copyright ©; 2022, Shchaeva S.N.Copyright ©; 2022, Щаева С.Н.2022Shchaeva S.N.Щаева С.Н.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/535

Objective: to identify the main factors associated with an increased risk of urgent complications of colorectal cancer.

Materials and methods. This retrospective cohort study included 214 patients with colorectal cancer who had undergone emergency surgery in Smolensk hospitals between January 2016 and January 2020. Their median age was 66 years. We analyzed patients’ sociodemographic characteristics (sex, age, settings (urban or rural), education, employment, profession, and family status), disease history, clinical characteristics (type of urgent complication, comorbidities), morphological tumor characteristics (histological type, pTNM stage, pattern of tumor growth (exo- or endophytic, mixed), tumor length along the intestine (<4 cm, 4–7 cm, >7 cm), presence of lymph node metastases and distant metastases). Multivariate logistic regression was used to analyze factors that were independently associated with an increased risk of decompensated intestinal obstruction and colon perforation.

Results. The most significant risk factors for decompensated intestinal obstruction included T4 stage (odds ratio (OR) 3.19; 95 % confidence interval (CI) 1.66–7.12; p <0.001), high-grade tumor G3–G4 (OR 2.93; 95 % CI 0.89–3.97; p = 0.008), and presence of competing diseases (OR 2.03; 95 % CI 1.84–2.39; p <0.001). The risk of perforation was higher among patients with T4 tumors (OR 3.74; 95 % CI 2.61–5.48; p <0.001), lymph node involvement (N+) (OR 1.61; 95 % CI 1.33–2.01; p <0.001), high-grade tumors G3–G4 (OR 3.56; 95 % CI 2.08–4.93; p <0.001), and diabetes mellitus requiring insulin therapy (OR 2.11; 95 % CI 1.78–2.42; p <0.001).

Conclusion. Elderly patients with stage III and IV colorectal cancer and high comorbidity are more likely do develop urgent complications, such as decompensated acute intestinal obstruction or tumor perforation.

Цель исследования – изучить основные факторы, оказывающие влияние на развитие ургентных осложнений колоректального рака.

Материалы и методы. В ретроспективное когортное исследование включали больных, страдающих колоректальным раком и перенесших экстренные хирургические вмешательства в период с января 2016 г. по январь 2020 г. в общехирургических стационарах г. Смоленска. Всего было включено 214 пациентов, медиана возраста пациентов составила 66 лет. Были проанализированы социально-демографические характеристики (пол, возраст, место проживания (городская или сельская местность), образование, трудовая занятость, профессиональный и семейный статусы), анамнестические сведения, клинические характеристики (вид ургентного осложнения, коморбидность), морфологические характеристики (гистологический тип опухоли, стадия pTNM, характер опухолевого роста (экзоили эндофитный, смешанный), размер опухоли по длине кишки (до 4 см, 4–7 см, >7 см), наличие метастазов в лимфатических узлах и отдаленное метастазирование). При помощи многофакторной логистической регрессии проанализированы факторы, оказавшие независимое наиболее статистически значимое влияние на развитие декомпенсированной кишечной непроходимости и перфорации опухоли толстой кишки.

Результаты. Большее влияние на развитие декомпенсированной кишечной непроходимости оказывали стадия заболевания – местный статус опухоли T4 (отношение шансов (ОШ) 3,19; 95 % доверительный интервал (ДИ) 1,66–7,12; p <0,001), высокая степень злокачественности опухоли G3–G4 (ОШ 2,93; 95 % ДИ 0,89–3,97; p = 0,008) и коморбидность – наличие конкурирующих заболеваний (ОШ 2,03; 95 % ДИ 1,84–2,39; p <0,001). На развитие перфорации больше влияли стадия заболевания – местный статус опухоли T4 (ОШ 3,74; 95 % ДИ 2,61–5,48; p <0,001) и наличие стадии N+ (ОШ 1,61; 95 % ДИ 1,33–2,01; p <0,001), высокая степень злокачественности опухоли G3–G4 (ОШ 3,56; 95 % ДИ 2,08–4,93; p <0,001) и коморбидность – наличие сахарного диабета, корригируемого инсулинотерапией (ОШ 2,11; 95 % ДИ 1,78–2,42; p <0,001).

Выводы. Пациенты старческого возраста с III и IV стадиями колоректального рака и при наличии высокой коморбидности с большей вероятностью могут иметь ургентные осложнения в виде декомпенсированной острой кишечной непроходимости и перфорации опухоли.

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